P515: A REAL-WORLD EVALUATION OF TREATMENT PATTERNS AND OUTCOMES OF ACUTE MYELOID LEUKEMIA INDUCTION THERAPIES IN THE COMMUNITY SETTING
Authors: Keri Maher, Cherrishe Brown-Bickerstaff, Ying Qiu, Ali Mcbride, Djibril Liassou, Jalyna Laney, Marné Garretson, David Huggar, Ajeet Gajra, Jiafan Chen, David Hughes
Journal: HemaSphere (2023)

Background: Acute myeloid leukemia (AML) is an aggressive hematologic malignancy of older adults (median age at diagnosis: 68 years); median overall survival (mOS) is low, even with treatment. The VIALE-A study (NCT02993523) changed the standard of care by combining venetoclax (VEN) with a hypomethylating agent (HMA), extending mOS from 9.6 months in the placebo + azacitidine group to 14.7 months in the VEN + azacitidine group (DiNardo CD, et al. NEJM. 2020;383:617-629). With the evolving treatment landscape and growing availability of less-intensive induction chemotherapy (IC), it is important to understand the impact of these treatments in the real world. Aims: To evaluate treatment patterns and clinical outcomes for patients with AML who received intensive IC, VEN-based treatment (eg, VEN + azacitidine), or non-VEN-based low-intensity (NVB-LI) treatment (eg, a single HMA) in the first-line (1L) setting. Methods: A retrospective, observational, multicenter, US-based cohort study was conducted utilizing electronic health record data from adults with AML who initiated 1L IC between 01/01/2016 and 12/31/2019, or 1L VEN-based treatment or 1L NVB-LI treatment between 01/01/2019 and 12/31/2020. Eligible patients had ≥ 6 months of follow-up after 1L initiation (or < 6 months due to death). Patients who received AML treatment as part of clinical trials were excluded. Remission was defined as a physician-reported best response of complete remission (CR), CR with incomplete hematologic improvement, or CR with no measurable residual disease. Time-to-event outcomes were assessed using the Kaplan–Meier method; all other data were summarized using descriptive statistics. Results: A total of 451 patients were included; 54% were male, 70% were White. Median follow-up was 17 months. Mean age at 1L initiation was 52, 73, and 76 years in the IC, VEN, and NVB-LI cohorts, respectively. Among the 207 patients in the IC cohort, 99% discontinued treatment during follow-up, 85% of whom discontinued due to completion of treatment. Among the 152 patients in the VEN cohort and 92 in the NVB-LI cohort, 72% and 75% discontinued treatment, respectively, primarily due to disease progression (59% and 68% of discontinuing patients, respectively). Median duration of 1L treatment was 2, 11, and 7 months in the IC, VEN and NVB-LI cohorts, respectively. In the IC, VEN, and NVB-LI cohorts, 80%, 45%, and 20% of patients achieved remission during 1L treatment; median time to remission was 1, 3, and 3 months, respectively. Median relapse-free survival was not reached during follow-up in any of the cohorts. In the IC cohort mOS was not reached; mOS was 17 months in the VEN cohort, and 9 months in the NVB-LI cohort. Summary/Conclusion: Patients receiving 1L IC had the highest rate of remission, the shortest time to remission, and the most favorable mOS among all treatment cohorts, supporting continued intensive chemotherapeutic approaches with curative intent in eligible patients. mOS favored combination VEN-based treatment over NVB-LI, suggesting that VEN-based therapies may provide more benefit for patients ineligible for IC. Further research is warranted to determine the most appropriate treatment approach for patients with AML based on treatment effectiveness, patient medical history, and IC eligibility. © 2023 American Society of Clinical Oncology, Inc. Reused with permission. This abstract was accepted and previously presented at the 2023 ASCO Annual Meeting. All rights reserved. Keywords: Acute myeloid leukemia, Induction chemotherapy, Real world data, Clinical outcome